List of Covered Drugs

The following is a list of drugs on the Hocks $5.00 Drug Program

Last Updated 5/2/12   (**) Denotes Exceptional Value

The GENERIC drugs listed here qualify for these prices

Tablet and Capsule Pricing is based on Quantity.

All other medications are based on a $5.00 incremental increase.
Example 1 tube of Ointment is $5.00, 2 tubes of Ointment would be $10.00 etc

Quantity	Price		Quantity	Price
1-30	$5.00		181-270	$35.00
31-60	$10.00		271-360	$45.00
61-90	$15.00		361-480	$60.00
91-120	$20.00		481-600	$75.00
121-180	$25.00		601-720	$90.00

Generic Drug Name   Acyclovir 200mg ** Acyclovir 400mg ** Allopurinol 100mg Allopurinol 300mg Amiodarone 200mg ** Amitriptyline 10mg Amitriptyline 25mg Amitriptyline 50mg Amitriptyline 75mg Amitriptyline 100mg Amitriptyline 150mg Amlodipine 2.5mg Amlodipine 5mg Amlodipine 10mg Armour Thyroid 15mg Armour Thyroid 30mg Armour Thyroid 60mg Atenolol 25mg Atenolol 50mg Atenolol 100mg Atenolol-Chlorthal 100/25 Atenolol-Chlorthal 50/25 Baclofen 10mg Baclofen 20mg Benazepril 5mg Benazepril 10mg Benazepril 20mg Benazepril 40mg Benazepril-Hctz 10/12.5 Benazepril-Hctz 20/12.5 Benazepril-Hctz 20/25 Benztropine 0.5mg Benztropine 1mg Benztropine 2mg Bisoprolol/Hctz 2.5/6.25 Bisoprolol/Hctz 5/6.25 Bisoprolol/Hctz 10/6.25 Bumetanide 0.5mg Bumetanide 1mg Bumetanide 2mg Buspirone 5mg Buspirone 10mg Buspirone 15mg Captopril 12.5mg Captopril 25mg Captopril 50mg Captopril 100mg Captopril/Hctz 25/15 Captopril/Hctz 25/25 Captopril/Hctz 50/25 Carbamazepine 100mg Carbamazepine 200mg Carbidopa/levodopa 25/100mg ** Carvedilol 3.125mg Carvedilol 6.25 mg Carvedilol 12.5mg Carvedilol 25mg Chlorzoxazone 500mg Cilostazol 50mg ** Cilostazol 100mg ** Cimetidine 300mg Cimetidine 400mg Cimetidine 800mg Citalopram 10mg Citalopram 20mg Citalopram 40mg Clomipramine 25mg Clonidine 0.1 mg Clonidine 0.2mg Clonidine 0.3mg Cyclobenzaprine 5mg Cyclobenzaprine 10mg Cyproheptadine 4mg Diclofenac Pot 50mg Dicyclomine 10mg Dicyclomine 20mg Digoxin .125mg Digoxin .25mg Diltiazem 30mg Diltiazem 60mg Diltiazem 90mg Divalproex Sod DR 125mg Divalproex Sod DR 250mg ** Divalproex Sod DR 500mg ** Donepezil 5mg Donepezil 10mg** Doxazosin 1mg Doxazosin 2mg Doxazosin 4mg Doxazosin 8mg Doxepin 10mg Doxepin 25mg Doxepin 50mg Doxepin 75mg Doxepin 100mg Enalapril 2.5mg Enalapril 5mg Enalapril 10mg Enalapril 20mg Enalapril/Hctz 5-12.5mg Enalapril-Hctz 10-25 mg Estradiol 0.5mg Estradiol 1mg Estradiol 2mg Famotidine 20mg Famotidine 40mg Fluoxetine 10mg Fluoxetine 20mg Fluphenazine 1mg Fluphenazine 2.5mg Fluphenazine 5mg Fluphenazine 10mg Folic Acid 1mg Furosemide 20mg Furosemide 40mg Furosemide 80mg Gabapentin 100mg Gabapentin 300mg ** Gabapentin 400mg** Gemfibrozil 600mg** Glimepiride 1mg Glimepiride 2mg Glimepiride 4mg Glipizide 5mg Glipizide 10mg Glipizide 5mg ER Glyburide 1.25mg Glyburide 2.5mg Glyburide 3mg Glyburide 5mg Glyburide 6mg Glyburide/Metform 2.5/500 Glyburide/Metform 5/500 Glyburide-Metformin 1.25/25 Haloperidol 0.5mg Haloperidol 1mg Haloperidol 2mg Haloperidol 5mg Hctz 12.5 mg Capsule Hydralazine 10mg Hydralazine 25mg Hydralazine 50mg Hochlorothiazide 12.5mg Tab Hochlorothiazide 25mg Hydrochlorothiazide 50mg Hydrocortisone 20mg Hydroxyzine Hcl 10mg Hydroxyzine Hcl 25mg Hydroxyzine Pamoate 25mg Hydroxyzine Pamoate 50mg Ibuprofen 400mg Ibuprofen 600mg Ibuprofen 800mg Imipramine 10mg Imipramine 25mg

$5 Qty   30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30

Generic Drug Name   Indapamide 1.25mg Indapamide 2.5mg Isosorbide 5mg Isosorbide 10mg Isosorbide 20mg Ketoprofen 50mg Ketoprofen 75mg Labetalol 100mg Labetalol 200mg Lamotrigine 25mg Lamotrigine 100mg Lamotrigine 150mg Lamotrigine 200mg Levothyroxine 25mcg Levothyroxine 50mcg Levothyroxine 75mcg Levothyroxine 88mcg Levothyroxine 100mcg Levothyroxine 112mcg Levothyroxine 125mcg Levothyroxine 137mcg Levothyroxine 150mcg Levothyroxine 175mcg Levothyroxine 200mcg Lisinopril 2.5mg Lisinopril 5mg Lisinopril 10mg Lisinopril 20mg Lisinopril 40mg Lisinopril/Hctz 20/25 Lisinopril-Hctz 10-12.5 Lisinopril-Hctz 20-12.5 Lithium Carbonate 150mg Lithium Carbonate 300mg Loperamide 2mg Losartan 25mg Losartan 50mg Losartan 100mg Losartan-Hctz 100-12.5mg Losartan-Hctz 100-25mg Losartan-Hctz 50-12.5mg Lovastatin 10mg Lovastatin 20mg Lovastatin 40mg Medroxyprogesterone 2.5mg Medroxyprogesterone 5mg Medroxyprogesterone 10mg Meloxicam 7.5mg Meloxicam 15mg Metformin 500mg Metformin 500mg ER Metformin 850mg Metformin 1000mg Methocarbamol 500mg Methocarbamol 750mg Methyldopa 250mg Metoclopramide 5mg Metoclopramide10mg Metoprolol Tartrate 25mg Metoprolol Tartrate 50mg Metoprolol Tartrate 100mg Mirtazine 15mg Tab Mirtazine 30mg Tab Nadolol 20mg Naproxen 250mg Naproxen 375mg Naproxen 500mg Nortriptyline 10mg Nortriptyline 25mg Omeprazole 20mg Cap** Oxybutynin 5mg Pantoprazole 20mg Pantoprazole 40mg** Paroxetine 10mg Paroxetine 20mg Paroxetine 30mg Paroxetine 40mg Pentoxyphylline 400mg Phenytoin 100mg Pramipexole 0.125mg** Pramipexole 1.5mg ** Pramipexole 0.25mg ** Pramipexole 0..5mg** Pramipexole 1mg ** Pravastatin 10mg Pravastatin 20mg ** Pravastatin 40mg ** Prednisone 1mg Prednisone 2.5mg Prednisone 5mg Prednisone 10mg Prednisone 20mg Propranolol 10mg Propranolol 20mg Propranolol 40mg Propranolol 80mg Quinapril 5mg Quinapril 10mg Quinapril 20mg Quinapril 40mg Ramipril 2.5mg Ramipril 5mg Ramipril 10mg Ranitidine 150mg Ranitidine 300mg Risperidone 0.25mg ** Risperidone 0.5mg ** Risperidone 1mg ** Risperidone 2mg ** Risperidone 2mg ** Risperidone 3mg ** Risperidone 4mg ** Sertraline 25mg Sertraline 50mg ** Sertraline 100mg ** Simvastatin 5mg Simvastatin 10mg Simvastatin 20mg ** Simvastatin 40mg ** Simvastatin 80mg ** Sotalol 80mg Sotalol 120mg Spironolactone 25mg Sulfasalazine 500mg Sulindac 150mg Tamoxifen 10mg Terazosin 1mg Terazosin 2mg Terazosin 5mg Terazosin 10mg Theophylline 100mg SA Theophylline 200mg SA Theophylline 300mg SA Tizanidine Hcl 2mg Tizanidine Hcl 4mg Topiramate 100mg ** Topiramate 200mg ** Topiramate 25mg Topiramate 50mg Trazodone 50mg Trazodone 100mg Trazodone 150mg Triamterene/Hctz 37.5/25 Tab Triamterene/Hctz 75/50 Verapamil 80mg Verapamil 120mg Warfarin Sodium 1mg Warfarin Sodium 2mg Warfarin Sodium 2.5mg Warfarin Sodium 3mg Warfarin Sodium 4mg Warfarin Sodium 5mg Warfarin Sodium 6mg Warfarin Sodium 7.5mg Warfarin Sodium 10mg Zonisamide 25mg Zonisamide 50mg Zonisamide 100mg

$5 Qty   30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30

$5.00 Tab/Cap Antibiotics Amoxicillin 250mg Capsule Amoxicillin 500mg Capsule Doxycycline 50mg Capsule Doxycycline 100mg Capsule Fluconazole 150mg Tablet Penicillin VK 250mg Tablet Sulfameth/Trimp 400/80 Tablet Sulfameth/Trimp DS Tablet	$5 Qty 30 30 30 30 1 30 30 30		Cough Products Promethazine 6.25mg/5ml Syrup Promethazine DM Syrup Benzonatate 100mg Capsule Albuterol Syrup 2mg/5ml Albuterol 0.083% Soln Ipratropium 0.02% Sol	$5 Qty 180ml 120ml 14 4oz 25/Box 25/Box
$10.00 Tab/Cap Antibiotics Azithromycin 250mg (Z-Pak)** Azithromycin 500mg (Tri-Pak)** Cephalexin 500mg Capsule Cephalexin 250mg Capsule Cephalexin 500mg Capsule** Ciprofloxacin 250mg Tablet Ciprofloxacin 500mg Tablet Clindamycin 150mg Capsule Levofloxacin 250mg Tablet ** Levofloxacin 500mg Tablet ** Metronidazole 250mg Tablet Metronidazole 500mg Tablet	$10 Qty 6 3 30 30 30 30 30 30 20 20 30 30		Creams/Ointments Gentamycin Cream Gentamycin Ointment Hydrocortisone 2.5% Cream Triamcinolone 0.1% Cream	$5 Qty 15gm 15gm 28gm 15gm
Liquid Antibiotics   Amoxicillin 125mg/5ml Liquid Amoxicillin 125mg/5ml Liquid Amoxicillin 125mg/5ml Liquid Amoxicillin 200mg/5ml Liquid Amoxicillin 200mg/5ml Liquid Amoxicillin 200mg/5ml Liquid Amoxicillin 250 mg/5ml Liquid Amoxicillin 250 mg/5ml Liquid Amoxicillin 250 mg/5ml Liquid Amoxicillin 400mg/5ml Liquid Amoxicillin 400mg/5ml Liquid Amoxicillin 400mg/5ml Liquid Amoxil 50mg/Drops Penicillin VK 125mg/5ml Penicillin VK 250mg/5ml Sulfa/Trimethoprim Liquid	$5 Qty 80ml 100ml 150ml 50ml 75ml 100ml 80ml 100ml 150ml 50ml 75ml 100ml 30ml 100ml 100ml 120ml		Other Products Alendronate 70mg 4ct** Chlorhexidine 0.12% Rinse 473ml Latanoprost 0.005% Eye 2.5ml ** Lidocaine Viscous 2% 100ml Phenazopyridine 100mg 30ct Phenazopyridine 200mg 30ct Nebulizer Adult	Price $5.00 $5.00 $15.00 $5.00 $5.00 $5.00 $49.00

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